This invention relates to an electrosurgical instrument for facial plastic surgery, in particular, to an electrosurgical electrode for rhinoplasty, a procedure to straighten a congenitally or traumatically deviated nose and septum.
To the best of our knowledge, this procedure has only been treated by using a scalpel and scissors. Due to the difficulty of gaining access to the inside of the nose, the use of a scalpel to make the intercartilaginous incisions is cumbersome. Frequently, the presence of excessive bleeding dramatically decreases visibility. Knives and septal scissors are further required to release and sculpt upper lateral cartilages while constantly protecting the overlying skin of the nasal dorsum. It is also recognized that cartilage tissue is typically tougher to remove than soft tissue, which further exacerbates the procedure. The result is that the known procedure is time consuming, inefficient and uncomfortable for the patient.
Typically, the surgeon and surgical staff have a very difficult time viewing the procedure and anatomy through the profuse blood produced by the scalpel and scissors. Maneuvering the instruments, stopping the bleeding, and doing a precise rhinoplasty are extremely difficult. It has been indicated that tolerances of less than 1 mm can have a profound effect on the ultimate surgical outcome. Among the main complications with this popular procedure are: 1) poor cosmetic/functional result; 2) septal perforation; and 3) orbital hemorrhage. Many of these serious complications to the patient are related to visibility of critical nasal anatomy and bleeding from the use of the scalpels and scissors. See xe2x80x9cAesthetic Facial Plastic Surgeryxe2x80x9d, ed. by Romo and Millman, published by Thieme, 2000, Ch. 7, whose contents are herein incorporated by reference.
An object of the invention is an improved rhinoplasty surgical procedure using a novel electrosurgical instrument.
We have invented novel electrodes for use in an electrosurgical rhinoplasty procedure. This electrosurgical procedure using our novel electrodes enables physicians to offer to patients a procedure that is efficiently performed, easily learned and thus performed at a significantly reduced cost, with less tissue damage compared to procedures done heretofore, and, most important, with improved visibility due to control of the bleeding during the procedure.
The procedure using our novel electrodes is based on performing essentially the same kind of rhinoplasty procedure as was used heretofore but, in accordance with a feature of our invention, the structure of our novel electrosurgical electrodes used to remove nasal cartilage tissue provides not only improved access to the cartilage requiring removal but in addition enables simpler removal of the undesired cartilage, much tougher tissue than soft tissue, without the excessive bleeding that impairs visibility of the surgical site.
A further feature of the electrodes of the invention is their size, angle, insulation, and active micro-thin wire to achieve ideal and easy access into the nose, septum, cartilage upper and lower and inferior turbinate.
In accordance with another feature of our invention, the electrode of the invention is uniquely configured to form an angled electrode working end terminating in an active, bare, transversely-extending, electrically-conductive, thin wire segment, preferably straight, whose width enables easy access to the constricted nasal cavity and controls the width of the cartilage planing treatment, and which in turn is terminated at opposite ends with protective electrically-insulating-coated segments each adjacent an end of the active thin wire segment. When the working active end of the activated electrode is applied to the nasal region to be treated, the bare wire delivers radiofrequency energy to the contacted nasal tissue causing the desired cartilage removal. At the protected ends, the electrically-insulating coating prevents the side supports of the active wire from inadvertently contacting and injuring nasal tissue that should remains undisturbed. The novel design with protected side segments will make removal of tough nasal cartilage easier and safer and with less bleeding. The active wire and its side segments are supported by structure that is completely electrically-insulated to avoid damage to surrounding tissue, and to allow the physician to use these inactive insulated parts to help position and guide the active wire segment, which is the only part capable of removing tissue, during the surgical procedure. In a preferred embodiment, the active-wire-supporting structure is Y-shaped.
In accordance with another feature of our invention, the electrode of the invention is uniquely configured to form an angled electrode with a long U-shaped-supported working end terminating in an active, bare, transversely-extending, electrically-conductive, thin wire segment, preferably straight, whose width enables easy access to the constricted nasal cavity and controls the width of the cartilage planing treatment, and which in turn is terminated at opposite ends with protective electrically-insulating-coated segments each adjacent an end of the active thin wire segment. This electrode is especially useful for reducing nasal humps. Similarly to the other preferred electrode, when the working active end of the activated electrode is applied to the nasal region to be treated, the bare wire delivers radiofrequency energy to the contacted nasal tissue causing the desired cartilage removal. As before, the electrically-insulating coating prevents the side supports of the active wire from inadvertently contacting and injuring nasal tissue that should remains undisturbed.
The electrosurgical procedure has the important advantage of being able to remove tough cartilage tissue with minimum surgeon pressure while at the same time coagulating the cut tissue causing minimum bleeding. It is preferred that the electrosurgical currents used be above 2 MHz, and preferably above 3 MHz. At these high frequencies, commonly referred to as radiosurgery, cutting is accomplished by volatilizing intracellular fluids at the point of the transmitting electrode contact which is primarily responsible for only small lateral heat spread and thus less damage to neighboring cell layers.
Employment of the invention allows the surgical staff to carry out this procedure with safety, precision and efficiency thus saving considerable time, substantially reduces the complication rate, as well as greatly increasing the success rate of the surgical intervention.
The various features of novelty which characterize the invention are pointed out with particularity in the claims annexed to and forming a part of this disclosure. For a better understanding of the invention, its operating advantages and specific objects attained by its use, reference should be had to the accompanying drawings and descriptive matter in which there are illustrated and described the preferred embodiments of the invention, like reference numerals or letters signifying the same or similar components.